TREATMENT OF ADVANCED HODGKINS-DISEASE WITH CHEMOTHERAPY - COMPARISONOF MOPP ABV HYBRID REGIMEN WITH ALTERNATING COURSES OF MOPP AND ABVD - A REPORT FROM THE NATIONAL-CANCER-INSTITUTE OF CANADA CLINICAL-TRIALS GROUP/

Purpose: This randomized, prospective trial compares outcomes for pati ents with advanced Hodgkin's disease treated with mechlorethamine, vin cristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD). Methods: Three hundred one patients with advanced Hodgkin's disease were randomized to recei ve MOPP/ABV hybrid regimen or alternating MOPP/ABVD after stratificati on for prior treatment, B symptoms, and treatment center. Eligible pat ients were either previously untreated and found to have stage IIIB, I VA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy . Those with residual disease in a localized region received irradiati on between the sixth and seventh cycle of treatment. Results: Response rates to the two regimens were similar. Five-year overall survival ra ces were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ABVD, re spectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 77% and 67% for MOP P/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%), Significantly more episodes of febril e neutropenia and stomatitis were observed with the MOPP/ABV hybrid re gimen; there was no significant difference in fatal toxicity, Patients with predefined, high-quality partial responses (PR-1s) had results s imilar to those with complete responses (CRs), planned subset analysis showed no significant difference in outcome between the two arms Of t he trial for patients with newly diagnosed disease (5-year failure-fre e survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for pat ients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017). Conclusion: MOPP/ABV hybrid and alternating MOPP/ABVD regim ens are equally effective for patients with advanced Hodgkin's disease . (C) 1997 by American Society of Clinical Oncology.